What’s Covered in Dental Insurance and How Can I Maximize It?

If you aren’t very familiar with your dental insurance plan, you may not know that certain dental procedures receive coverage in different ways. Certain dental services tend to get coverage from plans at different rates because they involve more time, materials, and expertise than others. If you want to get the most out of the plan you have in the current year, consider this brief refresher from a dentist ahead of your next appointment!

The 100-80-50 Model

While every dental insurance provider has unique stipulations and conditions for their coverage, they generally use the same model overall in most cases. This is referred to as a “100-80-50” model and it specifically focuses on the coverage rates for specific types of dental services you’re likely to receive at a dental office. Treatments fall into three distinct categories, including:

• Preventive Services – Usually includes checkups and cleanings, generally covered 100% or close to it by insurance
• Minor Restorative Services – Typically includes dental fillings and sometimes root canals, generally covered between 70% and 80% by insurance
• Major Restorative Services – Generally includes dental crowns, bridges, and dentures, often covered up to 50% by insurance

Your Benefits Won’t Be Around for Long

While dental insurance benefits can be very useful for covering dental insurance treatments, it’s important to keep in mind that these benefits typically expire at the end of the year, meaning you’ll need to pay your deductible again just to access them. Paying your premium every month is what also gives you access to these benefits, so if you never use them, you’re covering this expense for nothing.

How to Maximize Your Benefits Now

Thankfully, there are ways you can start maximizing your benefits today before they reset on January 1^st. Keep these tips in mind to help you get started on the process:

• Start reviewing your benefits now either with your insurance provider directly or with the help of a dental office. You may be able to see what benefits you have left through these methods alone.
• Make sure you’ve maximized all your preventive services, such as your checkups and cleanings. These generally receive the best coverage and are the most essential for your long-term oral health.
• Don’t be afraid to schedule appointments today that extend into the new year. This is a common tactic that people perform to max out any benefits they have left in the current year.

The best way to make the most of your plan is to visit a dentist in Frisco directly. They can help break down your coverage with you directly as well as file claim forms when the time comes to get your reimbursement. Schedule an appointment and start maximizing your insurance today!

About the Author

Dr. Caballeros and his team members are more than prepared to go over your insurance plan with you one-on-one and ensure you’re getting the most out of your plan. While they are in-network with several PPO insurances, you can still make your care affordable even if you are out-of-network. Give their office a call through their website and they’ll help you get started on the process!